learning activity # utilitarianism case study

Examples of Utilitarianism in Business: Utilitarianism Case Study

Case 1: blood for sale, case 2: wal-mart, case 3: webporn, case 4: housing allowance, case 5: challenger, works cited.

The utilitarianism theory focuses on the moral aspect of various actions and decisions that people make and it attempts to explain whether the actions or decisions are right or wrong. The analysis of ‘rightness’ and ‘wrongness’ of a decision or action often depends on the values that each society holds dear (Callcut 24).

Therefore, the theory focuses on the justification of behavior and decisions as either moral or immoral. The concept of morality is entirely abstract. Perceptions of right and wrong depend both on individual and societal perspectives of morality often for the good of the individual analyzing the same.

In most cases, when people choose to undertake an analysis of the morality of actions and decisions, they focus on matters of public interest such as issues concerning politics, economic policies, and social constructs (Lukes 12).

Utilitarianism operates on several premises and one of them is the concept that an action or decision is right if it only affects the doer to the exclusion of any other person around the individual (Mill 41). For instance, if a person decides to set his/her house on fire at will, s/he should do so at will as long as the fire at the house does not spread to other people’s houses or cause damage to the neighboring properties.

However, some people argue that although a person has a right to set his or her own house on fire, the action affects others indirectly through ways such as spreading smoke and ash to the neighboring properties. This argument has led to the development of the second premise in the theory, which states that in order for actions and decisions to qualify as right and moral, they must appeal to the happiness of the greatest number.

This assertion means that the majority of people in any society or setting in which the actions or decisions take place must be in agreement with the same (Ferrell et al. 67). Using the example applied above, the burning of the house would only be right and moral if a majority of the people living in the area surrounding the house were okay with the action.

The reason for this rule is to set a standard for right and wrong behaviors and decisions and prevent clumsy decisions by individuals that are likely to affect a majority of other people simply due to individual preferences of morality, especially by representatives of the people in various governments (Alexander 48).

The third premise that the theory propagates is the perception that actions and decisions should increase happiness and reduce suffering for the greatest number of people. The theory thus places emphasis on the results rather than the procedure when analyzing the morality of actions and decisions (Parson 97).

For instance, if a man steals to feed his children, the morality of the action depends on whether it reduces suffering and increases happiness. However, in order to prevent outrageous actions and decisions, especially from government representatives, the second premise applies when vetting the moral validity of such actions and decisions (Sartorious 75).

Jeremy Bentham is one of the earliest proponents of this theory. According to him, absolute morality is impracticable as a vast majority of people hold conflicting views on what qualifies as right and what qualifies as wrong.

Therefore, utilitarianism provides a base regarding consideration and analysis of what qualifies as moral in terms of actions and decisions, especially with reference to government officials, civil servants, and other key figures in society (Bentham 12).

John Stuart mill, also a proponent of the theory, contributes to the discussion through his observation that the theory is result-oriented coupled with supporting Bentham’s opinion on the matter (Mill and Bentham 34).

In order to create a better understanding of the theory and its application, this paper explores five cases. It gives an overview of the main concerns in the cases and their moral implications according to the application of the utilitarian theory.

Case summary: Sol Levin was a successful stockbroker in Tampa. He observed that in the United States, the blood used for transfusions mostly comes from donation from well-wishers. However, since most people are not willing to donate, there was a blood deficit in the country.

He considered this scenario as an opportunity for a profitable business, and thus together with some colleagues, they formed Plasma International. The company mainly deals with the location, purchase, supply, and sale of blood to individuals and organizations that need it for transfusion.

During the initial stages of the company’s operation, the company bought contaminated blood from alcoholics and drug addicts as only a few people in the country were willing to exchange their blood for money. However, the organization later found a village in Africa where people were more willing to sell their blood to the company at prices as low as fifteen cents a pint.

The company made deals with local chiefs for purchase of blood from people in the villages. The company resold the blood in the US at prices that were ten times higher than the purchase price. In the US, about forty percent of people donate blood to build up credit so that they do not buy blood when they need it later.

In comparison, the National Health Service in the Great Britain relies solely on blood donations. The justification for the British system is that blood is something that can dictate whether a person lives or dies. Denying that person blood, especially if voluntary donors offer it, because the person cannot afford the blood is wrong and thus immoral.

Discussion and application: The main issue in this case is whether sale and purchase of blood for profit is moral. Richard Tittmus presents his opinion in support of the British system by stating that selling blood as a commodity reduces the need for people to donate blood, thus resulting in less blood in most blood banks (Steiner 149).

Additionally, when people place a price on their blood, they place high values on it, thus leaving companies like Plasma International with little demand.

Using the utilitarian theory, the morality in selling blood depends on the societal values coupled with what the majority of the population considers as right. In the US, since the system of blood sale is acceptable in society, the act is moral.

However, people in the Great Britain might consider the same as immoral for in their eyes, people donate blood as an act of altruism to save another person’s life. Selling blood like any other commodity degrades its intrinsic value.

Case summary: Wal-Mart is currently the world’s largest retail franchise. It has over 4,750 stores and it attracts about 138 million shoppers every week. Consequently, the franchise has gained enormous influence in the market place, thus controlling up to thirty percent of the household market staples. Most companies selling consumer products such as foods consider the company’s reach as an advantage to their businesses.

Consumers also benefit heavily from the low prices that the company sets for most products. However, some entities see the company as a hindrance to their progress and development. For instance, local businesses in most areas in the US consider the franchise a threat for its affordable prices attract customers previously loyal to such local businesses, thus running them out of business.

Closure of consumer-based businesses in such local communities often leads to loss of jobs, thus creating a monopoly while stifling the economy due to tax considerations that Wal-Mart stores get in most areas. Such occurrences destabilize entire communities.

Additionally, regardless of the profit that the company makes, it provides poor pay for employees without health insurance. The company thus has a high employee turnover of 44%. The company also uses its influence to dictate which products to stock on its shelves. This aspect has created a situation where some companies miss sales and profits while others get an unfair advantage.

Additionally, the company often uses its influence to control prices for goods from companies from which it stocks its products. The company has a tradition of advocating for low purchase prices from suppliers so that it can provide similarly lower prices when selling to its customers. This element is its trademark strategy and it has made the company and customers happy, even while leaving suppliers and local businesses in losses.

Discussion and application: The ethical issues that arise in this scenario is whether it is right for the company to expand without considering the local businesses in the areas of operation and whether the company has moral justification to alter market dynamics and force suppliers to lower prices in order to attract customers to its stores.

The application of the utilitarian theory to the case reveals that the determination of the morality of such actions depends on the group of people forming the majority at a given time. For instance, if customers form the majority, the actions are moral as they generate the greatest happiness and least suffering to consumers.

On the other hand, if the suppliers and local business owners form the majority, then Wal-Mart’s move would be wrong and immoral as it generates more pain than happiness to the greatest number of people.

In addition, application of the utilitarian theory reveals that the low wages to employees is wrong as the employees form a greater number as compared to the management of the company and the decision does not apply to the reduction of suffering concept for the majority, viz. the employees.

The franchise uses rules set by governments on businesses, and thus they apply equally to all business entities. Therefore, it is also possible that the company does not break any legal rules while conducting business, thus making its decisions rightful, hence moral.

Case Summary: Al Smetana, the CEO of Rayburn Unlimited Company, has built the company on foundations of honesty, integrity, and acknowledging the values that every individual at the company possesses. One day, he realized that an employee had found a way of accessing emails belonging to other people at the company. He immediately asked the employee to leave the company for violating the code of conduct.

As the employee was leaving, he made some remarks in anger regarding the vice president of the human resources division at the company, Mr. Craig Lindsey. The employee alleged that Lindsey used his computer to watch pornography.

At the time, Al Smetana was skeptical about the allegation, but later he decided to call Lindsey in his office and make inquiries. During the meeting, Lindsey accepted the allegations amid tears and stated that he was addicted to it and he was trying to stop. He asked the CEO for help, but Smetana said he needed time to think about the matter.

Discussion and application: The scenario creates a dilemma for Al Smetana where on one hand, he does not want to lose a friend, but on the other hand, he does not want to apply double standards and fail to abide by his own rules.

This scenario brings out Bentham’s point on morality as being an abstract concept that requires certain rules in order to apply to diverse situations without changing the core values. In this case, the rules are the presumptions that form the utilitarian theory. Application of the theory to the situation in this case will depend on the desired outcome as well as the company rules.

Summary: This case revolves around Wilson Mutambara, an employee of NewComm, a cellular telephone service based in the US with branches in different locations including Rambia, which is Mutambara’s native home. Mutambara was brought up in shanties in his native country.

The area in which he grew was a slum. However, he overcame many challenges and worked hard to obtain a scholarship to study in the US after his high school education. He received MBA and got employment at the company. After three years in the company, his employer offered him the opportunity to return to his home of birth where he was working.

He excitedly accepted the opportunity and moved back to Rambia as his new workstation. The company set apart enough money for his utilities. In order to ensure that the employees utilized their allowance adequately, the company required its employees to produce receipts indicating an itemized list of expenditure preferences, with which Mutambara always complied.

Fifteen months into the job, a co-worker, Dale Garman, found out that Mutambara lived in a slum and alerted Mutambara’s supervisor, Barbara Weston, on the issue. Weston confronted Mutambara on the matter. Her concern on the issue was that the housing conditions that he chose to live with were unbecoming of an employee of his caliber at the company.

However, Mutambara defended his actions stating that even though the information in the monthly receipts was false; his reasons for doing so were justifiable. One of his justifications for his actions was that every employee in the company received the same allowance and exempting him from the same payment plan would amount to discriminatory actions by the company.

He also argued that wherever he chose to live was his choice and that he did it to support his kin back home. He stated that it would be unreasonable for him to live in a mansion while his kin did not have enough food to eat. Lastly, he accused the company of being insensitive to the feeling of the people living in the slums by terming it as unseemly.

Discussion and application: In this case, several moral issues stand out, with the main ones being whether Weston’s opinion of the slum as being unseemly was right and whether Mutambara was right to falsify receipts for a good reason. The issue of whether Mutambara’s argument that he was receiving payment like every other employee and had the right to use it as he wished was justified also stands out.

In applying the utilitarian theory to the first issue, the concept behind the opinion of the two parties depends mainly on the societies in which they grew up. Weston grew up in the US, which explains her sense of disgust towards slums in Rambia. On the other hand, Mutambara grew up in Rambia, hence his pride in the place.

According to the utilitarian theory, the majority for which the greatest happiness should be applied is the people of Rambia, as that is the location for the company at the time of the argument.

Mutambara’s falsification of receipts was wrong according to the theory as it affected the entire company and its reputation negatively. However, Mutambara’s claim for equality as an employee of the company was valid according the greatest happiness of the greatest number principle.

Case Summary: This case regards the 1986 detonation of the space shuttle, Challenger, whereby seven astronauts died. The event caused the shuttle’s grounding until safe flight was achievable. The explosion occurred due to low temperatures that caused the shuttle’s O-rings not to seal its joints properly, thus leading to an explosion.

Morton Thoikol Inc. was the responsible company for the manufacture of the booster rockets. During an investigation into the matter, it became apparent that one of Thoikol’s employees, Roger Boisjoly, had warned the company and NASA about the O-rings and predicted that the shuttle’s critical joints would be unable to seal on liftoff due to low temperatures.

On the evening of liftoff, Boisjoly and his fellow engineers advised their employers, but Thoikol and NASA declined to act. Boisjoly underwent dismissal from being a member of the commission investigating the issue, but the commission reinstated him after complaints that the action was paramount to punishment. However, he left the job a short while later on extended sick leave.

Discussion and application: The main moral issue in this case is whether Boisjoly had an obligation to the public to publicize the matter in order to prevent similar accidents in the future and the eventual launch of the shuttle later on. The utilitarian theory proposes, in this case, that the greatest number for which people should consider when making such decisions is the public.

Therefore, Boisjoly’s decision ought to be one that gives the greatest felicity for the greatest number. According to Bentham’s conceptualization of the theory, Boisjoly’s decision is a personal decision that mainly affects him in terms of retention of employment. Therefore, choosing what is best for himself would mean keeping the information secret in order to retain his job.

However, the impact of his decision would affect the public in terms of loss of more lives if the shuttle launched later without proper checks. Therefore, testifying on the matter is his obligation in his capacity as an engineer to protect public interests.

The decision would reduce pain by preventing future incidents and increase happiness by ensuring the procurement of justice for the dead astronauts. However, a dilemma occurs when considering the obligation that an employee has to his employer, in this case Thoikol and NASA. The best way for him to handle the issue would be to inform his employers of his concerns before deciding to publicize the matter.

Alexander, Samuel. Moral Order and Progress: An analysis of ethical conceptions, Boston: Adamant Media Corporation, 2005. Print.

Bentham, Jeremy. An Introduction to the Principles of Morals and Legislation, New York: Dover Publications, 2007. Print.

Callcut, Daniel. “Mill, sentimentalism, and the problem of moral authority.” Utilitas 21.1 (2009): 22-35. Print.

Ferrell, Odies, John Fraedrich, and Linda Ferrell. Business Ethics: Ethical Decision Making and Cases , New York: Cengage, 2013. Print.

Parson, Patricia. Ethics in Public Relations: A Guide to Best Practice, London: Kogan Page, 2004. Print.

Lukes, Steven. Moral Relativism, London: Picador Publisher, 2008. Print.

Mill, John, and Jeremy Bentham. Utilitarianism and other essays , London: Penguin Books, 2004. Print.

Sartorious, Rolf. Individual Conduct and Social Norms: A Utilitarian Account of Social Union and the Rule of Law, Charleston: BookSurge Publishing, 2009. Print.

Steiner, Philippe. “Gifts of blood and organs: The market and “fictitious” commodities.” French Journal of Sociology 44.3 (2003): 147-162. Print.

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IvyPanda. (2022, July 31). Examples of Utilitarianism in Business: Utilitarianism Case Study. https://ivypanda.com/essays/utilitarianism-theory-case-study/

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Bibliography

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6.2.1: Utilitarianism

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• Russ W. Payne
• Bellevue College

Utilitarianism is based on the idea that happiness is good. Utilitarian thinkers have traditionally understood happiness in terms of pleasure and the absence of pain. Utilitarianism’s best known advocate, John Stuart Mill, characterizes Utilitarianism as the view that “an action is right insofar as it tends to produce pleasure and the absence of pain.” If happiness, conceived of as pleasure and the absence of pain, is the one thing that has value, then this criterion of right action should seem to follow straightforwardly.

In any given scenario, every possible course of action will have a utility. The utility of an action is the net total of pleasure caused by the action minus any pain caused by that action. In calculating the utility of an action we are to consider all of the effects of the action, both long run and short run. Given the utilities of all available courses of action, Utilitarianism says that the correct course of action is the one that has the greatest utility. So an action is right if it produces the greatest net total of pleasure over pain of any available alternative action. Note that sometimes no possible course of action will produce more pleasure than pain. This is not a problem for Utilitarianism as we’ve formulated it. Utilitarianism will simply require us to pursue the lesser evil. The action with the highest utility can still have negative utility.

Utilitarianism places no privileged status on the happiness of the actor. It’s happiness that matters, not just your happiness. So Utilitarianism can call for great personal sacrifice. The happiness of my child over the course of his lifetime might require great personal sacrifice on my part over the course of his first few decades. Utilitarianism says the sacrifice should be made given that the utility at stake for my child is greater than the utility at stake in my child-rearing sacrifices.

Likewise, Utilitarianism places no privileged status on the immediate, as opposed to the long term, effects of the action. An action’s utility is the net amount of pleasure or pain that is experienced as a result of the action over the long run. So, while it might maximize a small child’s pleasure in the short run to be given ice cream whenever he wants it, the long run utility of this might not be so good given the habits formed and the health consequences of an over- indulged sweet tooth.

There is an obvious concern to address at this point. We often don’t know what the long-run consequences of our actions will be, and even in the short run we are often uncertain about just how much pleasure and pain will be caused for the various parties affected. So we might not be able to calculate the utilities of alternative actions to figure out which action will have the highest utility. These are practical problems for applying utilitarian theory. But while it might be difficult to tell on a case by case basis just which course of action will maximize utility, this is not a problem for Utilitarianism as a normative ethical theory. As a normative ethical theory, Utilitarianism is aimed at identifying the standard for right action, not telling when a particular action meets that standard. Setting the standard for right action and figuring out how to meet that standard are two different projects.

When we speak of utility as pleasure and the absence of pain, we need to take “pleasure” and “pain” in the broadest sense possible. There are social, intellectual, and aesthetic pleasures to consider, as well as sensual pleasures. Recognizing this is important to answering what Mill calls the “doctrine of swine” objection to Utilitarianism. This objection takes Utilitarianism to be unfit for humans because it recognizes no higher purpose to life than the mere pursuit of pleasure. The objector takes people to have more noble ends to pursue than mere pleasure. According to this objection, Utilitarianism is a view of the good that is fit only for swine. Mill responds that it is the person who raises this objection who portrays human nature in a degrading light, not the utilitarian theory of right action. People are capable of pleasures beyond mere sensual indulgences and the utilitarian theory concerns these as well. Mill then argues that social and intellectual pleasures are of an intrinsically higher quality than sensual pleasure.

We find a more significant objection to Utilitarian moral theory in the following sort of case: Consider Bob, who goes to the doctor for a checkup. His doctor finds that Bob is in perfect health. And his doctor also finds that Bob is biologically compatible with six other patients she has who are all dying of various sorts of organ failure. Let’s assume that if Bob lives out his days he will live a typically good life, one that is pleasant to Bob and also brings happiness to his friends and family. But we will assume that Bob will not discover a cure for AIDS or bring about world peace. And let us make similar assumptions about the six people suffering from organ failure. According to simple Act Utilitarianism, it looks like the right thing for Bob’s doctor to do is to kill Bob and harvest his organs for the benefit of the six patients who will otherwise die. But intuitively, this would be quite wrong. Act Utilitarianism gets the wrong result in this sort of case. This case seems to provide a clear counterexample to simple Act Utilitarianism. This looks like a bit of evidence that calls for a change in theory. But perhaps that change can be a modification of utilitarian thinking rather than a complete rejection of it.

One move open to the utilitarian is to evaluate rules for acting rather than individual actions. A version of Rule Utilitarianism might say that the right action is the action that follows the rule which, in general, will produce the highest utility. A rule that tells doctors to kill their patients when others require their organs would not have very high utility in general. People would avoid their doctors and illness would go untreated were such a rule in effect. Rather, the rule that doctors should do no harm to their patients would have much higher utility in general. So the move to Rule Utilitarianism seems to avoid the difficulty we found with Act Utilitarianism. Or at least it seems to when we consider just these two rules.

But here is a rule that would have even higher utility than the rule that doctors should never harm their patients: doctors should never harm their patients except when doing so would maximize utility. Now suppose that doctors ordinarily refrain from harming their patients and as a result people trust their doctors. But in Bob’s case, his doctor realizes that she can maximize utility by killing Bob and distributing his organs. She can do this in a way that no one will ever discover, so her harming Bob in this special case will not undermine people’s faith in the medical system.The possibility of rules with “except when utility is maximized” clauses renders Rule Utilitarianism vulnerable to the same kinds of counterexamples we found for Act Utilitarianism. In effect, Rule Utilitarianism collapses back into Act Utilitarianism.

In order to deal with the original problem of Bob and his vital organs, the advocate of Rule Utilitarianism must find a principled way to exclude certain sorts of utility maximizing rules. I won’t pursue this matter on behalf of the utilitarian. Rather, I want to consider further just how simple Act Utilitarianism goes wrong in Bob’s case. Utilitarianism evaluates the goodness of actions in terms of their consequences. For this reason, Utilitarianism is often referred to as a consequentialist theory. Utilitarian considerations of good consequences seem to leave out something that is ethically important. Specifically, in this case, it leaves out a proper regard for Bob as person with a will of his own. What makes Bob’s case a problem case is something other than consequences, namely, his status as a person and the sort of regard this merits. This problem case for utilitarian moral theory seems to point towards the need for a theory based on the value of things other than an action’s consequences. Such non-consequentialist ethical theory is called deontological ethical theory. The best known deontological theory is the ethics of respect for persons. And this will be our next topic.

Here is a link to John Stuart Mill’s essay Utilitarianism : http://www.gutenberg.org/files/11224/11224-h/11224-h.htm

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3.2: Utilitarianism- The Greater Good

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Learning Objectives

• Define utilitarian ethics.
• Show how utilitarianism works in business.
• Distinguish forms of utilitarianism.
• Consider advantages and drawbacks of utilitarianism.

The College Board and Karen Dillard

“Have you seen,” the blog post reads, “their parking lot on a Saturday?” “CB-Karen Dillard Case Settled-No Cancelled Scores,” College Confidential, accessed May 15, 2011, http://talk.collegeconfidential.com/parents-forum/501843-cb-karen-dillard-case-settled-no-cancelled-scores.html . It’s packed. The lot belongs to Karen Dillard College Prep (KDCP), a test-preparation company in Dallas. Like the Princeton Review, they offer high schoolers courses designed to boost performance on the SAT. Very little real learning goes on in these classrooms; they’re more about techniques and tricks for maximizing scores. Test takers should know, for example, whether a test penalizes incorrect answers. If it doesn’t, you should take a few minutes at each section’s end to go through and just fill in a random bubble for all the questions you couldn’t reach so you’ll get some cheap points. If there is a penalty, though, then you should use your time to patiently work forward as far as you can go. Knowing the right strategy here can significantly boost your score. It’s a waste of brain space, though, for anything else in your life.

Some participants in KDCP—who paid as much as $2,300 for the lessons—definitely got some score boosting for their money. It was unfair boosting, however; at least that’s the charge of the College Board, the company that produces and administers the SAT.

Here’s what happened. A KDCP employee’s brother was a high school principal, and he was there when the SATs were administered. At the end of those tests, everyone knows what test takers are instructed to do: stack the bubble sheets in one pile and the test booklets in the other and leave. The administrators then wrap everything up and send both the answer sheets and the booklets back to the College Board for scoring. The principal, though, was pulling a few test booklets out of the stack and sending them over to his brother’s company, KDCP. As it turns out, some of these pilfered tests were “live”—that is, sections of them were going to be used again in future tests. Now, you can see how getting a look at those booklets would be helpful for someone taking those future tests.

Other stolen booklets had been “retired,” meaning the specific questions inside were on their final application the day the principal grabbed them. So at least in these cases, students taking the test-prep course couldn’t count on seeing the very same questions come exam day. Even so, the College Board didn’t like this theft much better because they sell those retired tests to prep companies for good money.

When the College Board discovered the light-fingered principal and the KDCP advantage, they launched a lawsuit for infringement of copyright. Probably figuring they had nothing to lose, KDCP sued back. Paulina Mis, “College Board Sues Test-Prep Company, Countersuit Filed,” Scholarships.com, February 26, 2008, accessed May 15, 2011, http://www.scholarships.com/blog/high-school/college-board-sues-test-prep-company-countersuit-filed/161 .

College Board also threatened—and this is what produced headlines in the local newspaper—to cancel the scores of the students who they determined had received an unfair advantage from the KDCP course. As Denton Record-Chronicle reported (and as you can imagine), the students and their families freaked out.Staci Hupp, “SAT Scores for Students Who Used Test Prep Firm May Be Thrown Out,” Denton Record Chronicle , February 22, 2008, accessed May 15, 2011. The scores and full application packages had already been delivered to colleges across the country, and score cancellation would have amounted to application cancellation. And since many of the students applied only to schools requiring the SAT, the threat amounted to at least temporary college cancellation. “I hope the College Board thinks this through,” said David Miller, a Plano attorney whose son was apparently on the blacklist. “If they have a problem with Karen Dillard, that’s one thing. But I hope they don’t punish kids who wanted to work hard.”

Predictably, the episode crescendoed with everyone lawyered up and suits threatened in all directions. In the end, the scores weren’t canceled. KDCP accepted a settlement calling for them to pay $600,000 directly to the College Board and provide $400,000 in free classes for high schoolers who’d otherwise be unable to afford the service. As for the principal who’d been lifting the test booklets, he got to keep his job, which pays about $87,000 a year. The CEO of College Board, by the way, gets around $830,000. “AETR Report Card,” Americans for Educational Testing Reform, accessed May 15, 2011, www.aetr.org/college-board.php. KDCP is a private company, so we don’t know how much Karen Dillard or her employees make. We do know they could absorb a million-dollar lawsuit without going into bankruptcy. Finally, the Plano school district in Texas—a well-to-do suburb north of Dallas—continues to produce some of the nation’s highest SAT score averages.

One Thief, Three Verdicts

Utilitarianism is a consequentialist ethics—the outcome matters, not the act. Among those who focus on outcomes, the utilitarians’ distinguishing belief is that we should pursue the greatest good for the greatest number . So we can act in whatever way we choose—we can be generous or miserly, honest or dishonest—but whatever we do, to get the utilitarian’s approval, the result should be more people happier. If that is the result, then the utilitarian needs to know nothing more to label the act ethically recommendable. (Note: Utility is a general term for usefulness and benefit, thus the theory’s name. In everyday language, however, we don’t talk about creating a greater utility but instead a greater good or happiness.)

In rudimentary terms, utilitarianism is a happiness calculation. When you’re considering doing something, you take each person who’ll be affected and ask whether they’ll end up happier, sadder, or it won’t make any difference. Now, those who won’t change don’t need to be counted. Next, for each person who’s happier, ask, how much happier? Put that amount on one side. For each who’s sadder, ask, how much sadder? That amount goes on the other side. Finally, add up each column and the greater sum indicates the ethically recommendable decision.

Utilitarian ethics function especially well in cases like this: You’re on the way to take the SAT, which will determine how the college application process goes (and, it feels like, more or less your entire life). Your car breaks down and you get there very late and the monitor is closing the door and you remember that…you forgot your required number 2 pencils. On a desk in the hall you notice a pencil. It’s gnawed and abandoned but not yours. Do you steal it? Someone who believes it’s an ethical duty to not steal will hesitate. But if you’re a utilitarian you’ll ask: Does taking it serve the greater good? It definitely helps you a lot, so there’s positive happiness accumulated on that side. What about the victim? Probably whoever owns it doesn’t care too much. Might not even notice it’s gone. Regardless, if you put your increased happiness on one side and weigh it against the victim’s hurt on the other, the end result is almost certainly a net happiness gain. So with a clean conscience you grab it and dash into the testing room. According to utilitarian reasoning, you’ve done the right thing ethically (assuming the pencil’s true owner isn’t coming up behind you in the same predicament).

Pushing this theory into the KDCP case, one tense ethical location is the principal lifting test booklets and sending them over to his brother at the test-prep center. Everything begins with a theft. The booklets do in fact belong to the College Board; they’re sent around for schools to use during testing and are meant to be returned afterward. So here there’s already the possibility of stopping and concluding that the principal’s act is wrong simply because stealing is wrong. Utilitarians, however, don’t want to move so quickly. They want to see the outcome before making an ethical judgment. On that front, there are two distinct outcomes: one covering the live tests, and the other the retired ones.

Live tests were those with sections that may appear again. When students at KDCP received them for practice, they were essentially receiving cheat sheets. Now for a utilitarian, the question is, does the situation serve the general good? When the testing’s done, the scores are reported, and the college admissions decisions made, will there be more overall happiness then there would’ve been had the tests not been stolen? It seems like the answer has to be no. Obviously those with great scores will be smiling, but many, many others will see their scores drop (since SATs are graded on a curve, or as a percentile). So there’s some major happiness for a few on one side balanced by unhappiness for many on the other. Then things get worse. When the cheating gets revealed, the vast majority of test takers who didn’t get the edge are going to be irritated, mad, or furious. Their parents too. Remember, it’s not only admission that’s at stake here but also financial aid, so the students who didn’t get the KDCP edge worry not only that maybe they should’ve gotten into a better school but also that they end up paying more too. Finally, the colleges will register a net loss: all their work in trying to admit students on the basis of fair, equal evaluations gets thrown into question.

Conclusion. The theft of live tests fails the utilitarian test. While a few students may come out better off and happier, the vast majority more than balances the effect with disappointment and anger. The greater good isn’t served.

In the case of the theft of “retired” tests where the principal forwarded to KDCP test questions that won’t reappear on future exams, it remains true that the tests were lifted from the College Board and it remains true that students who took the KDCP prep course will receive an advantage because they’re practicing the SAT. But the advantage doesn’t seem any greater than the one enjoyed by students all around the nation who purchased prep materials directly from the College Board and practiced for the exam by taking old tests. More—and this was a point KDCP made in their countersuit against the College Board—stealing the exams was the ethically right thing to do because it assured that students taking the KDCP prep course got the same level of practice and expertise as those using official College Board materials. If the tests hadn’t been stolen, then wouldn’t KDCP kids be at an unfair disadvantage when compared with others because their test practices hadn’t been as close to the real thing as others got? In the end, the argument goes, stealing the tests assured that as many people as possible who took prep courses got to practice on real exams.

Conclusion. The theft of the exams by the high school principal may conceivably be congratulated by a utilitarian because it increases general happiness. The students who practiced on old exams purchased from the College Board can’t complain. And as for those students at KDCP, their happiness increases since they can be confident that they’ve prepared as well as possible for the SAT.

The fact that a utilitarian argument can be used to justify the theft of test booklets, at least retired ones, doesn’t end the debate, however. Since the focus is on outcomes, all of them have to be considered. And one outcome that might occur if the theft is allowed is, obviously, that maybe other people will start thinking stealing exam books isn’t such a bad idea. If they do—if everyone decides to start stealing—it’s hard to see how anything could follow but chaos, anger, and definitely not happiness.

This discussion could continue as more people and consequences are factored in, but what won’t change is the basic utilitarian rule. What ought to be done is determined by looking at the big picture and deciding which acts increase total happiness at the end of the day when everyone is taken into account.

Should the Scores Be Canceled?

After it was discovered that KDCP students got to practice for the SATs with live exams, the hardest question facing the College Board was, should their scores be canceled? The utilitarian argument for not canceling is straightforward. Those with no scores may not go to college at all next year. This is real suffering, and if your aim is to increase happiness, then counting the exams is one step in that direction. It’s not the last step, though, because utilitarians at the College Board need to ask about everyone else’s happiness too: what’s the situation for all the others who took the exam but have never heard of KDCP? Unfortunately, letting the scores be counted is going to subtract from their happiness because the SAT is graded comparatively: one person doing well means everyone getting fewer correct answers sees their score drop, along with college choices and financial aid possibilities. Certainly it’s true that each of these decreases will be small since there were only a handful of suspect tests. Still, a descent, no matter how tiny, is a descent, and all the little bits add up.

What’s most notable, finally, about this decision is the imbalance. Including the scores of KDCP students will weigh a tremendous increase in happiness for a very few against a slight decrease for very many. Conversely, a few will be left very sad, and many slightly happier. So for a utilitarian, which is it? It’s hard to say. It is clear, however, that this uncertainty represents a serious practical problem with the ethical theory. In some situations you can imagine yourself in the shoes of the different people involved and, using your own experience and knowledge, estimate which decision will yield the most total happiness. In this situation, though, it seems almost impossible because there are so many people mixed up in the question.

Then things get still more difficult. For the utilitarian, it’s not enough to just decide what brings the most happiness to the most individuals right now; the future needs to be accounted for too. Utilitarianism is a true global ethics ; you’re required to weigh everyone’s happiness and weigh it as best as you can as far into the future as possible. So if the deciders at the College Board follow a utilitarian route in opting to include (or cancel) the scores, they need to ask themselves—if we do, how will things be in ten years? In fifty? Again, these are hard questions but they don’t change anything fundamental. For the utilitarian, making the right decision continues to be about attempting to predict which choice will maximize happiness.

Utilitarianism and the Ethics of Salaries

When he wasn’t stealing test booklets and passing them on to KDCP, the principal in the elite Plano school district was dedicated to his main job: making sure students in his building receive an education qualifying them to do college-level work. Over at the College Board, the company’s CEO leads a complementary effort: producing tests to measure the quality of that preparation and consequently determine students’ scholastic aptitude. The principal, in other words, is paid to make sure high schoolers get an excellent education, and the CEO is paid to measure how excellent (or not) the education is.

Just from the job descriptions, who should get the higher salary? It’s tempting to say the principal. Doesn’t educating children have to be more important than measuring how well they’re educated? Wouldn’t we all rather be well educated and not know it than poorly educated and painfully aware of the fact?

Regardless, what’s striking about the salary that each of these two actually receives isn’t who gets more; it’s how much. The difference is almost ten times: $87,000 for the principal versus the CEO’s $830,000. Within the doctrine of utilitarianism, can such a divergence be justified?

Yes, but only if we can show that this particular salary structure brings about the greatest good, the highest level of happiness for everyone considered as a collective. It may be, for example, that objectively measuring student ability, even though it’s less important than instilling ability, is also much harder. In that case, a dramatically higher salary may be necessary in order to lure high-quality measuring talent. From there, it’s not difficult to fill out a utilitarian justification for the pay divergence. It could be that inaccurate testing would cause large amounts of unhappiness: students who worked hard for years would be frustrated when they were bettered by slackers who really didn’t know much but managed to score well on a test.

To broaden the point, if tremendous disparities in salary end up making people happier, then the disparities are ethical. Period. If they don’t, however, then they can no longer be defended. This differs from what a libertarian rights theorist might say here. For a libertarian—someone who believes individuals have an undeniable right to make and keep whatever they can in the world, regardless of how rich or poor anyone else may be—the response to the CEO’s mammoth salary is that he found a way to earn it fair and square, and everyone should quit complaining about it. Generalized happiness doesn’t matter, only the individual’s right to try to earn and keep as much as he or she can.

Can Money Buy Utilitarian Happiness? The Ford Pinto Case

Basic questions in business tend to be quantitative, and money is frequently the bottom line: How many dollars is it worth? What’s my salary? What’s the company’s profit? The basic question of utilitarianism is qualitative: how much happiness and sadness is there? Inevitably, it’s going to be difficult when businesses accustomed to bottom-line number decisions are forced to cross over and decide about general happiness. One of the most famous attempts to make the transition easier occurred back in the 1970s.

With gas prices on the rise, American car buyers were looking for smaller, more efficient models than Detroit was manufacturing. Japanese automakers were experts in just those kinds of vehicles and they were seizing market share at an alarming rate. Lee Iaccoca, Ford’s president, wanted to rush a car into production to compete. His model was the Pinto.Case facts taken from Manuel Velasquez, Business Ethics, Concepts and Cases , 6th ed. (Upper Saddle River, NJ: Pearson Prentice Hall, 2006), 60–61.

A gas sipper slated to cost $2,000 (about $12,000 today), Ford rushed the machine through early production and testing. Along the way, unfortunately, they noticed a design problem: the gas tank’s positioning in the car’s rump left it vulnerable to rear-end collisions. In fact, when the rear-end hit came faster than twenty miles per hour, not only might the tank break, but gasoline could be splattered all the way up to the driver’s compartment. Fire, that meant, ignited by sparks or anything else could engulf those inside.

No car is perfectly safe, but this very scary vulnerability raised eyebrows. At Ford, a debate erupted about going ahead with the vehicle. On the legal end, the company stood on solid ground: government regulation at the time only required gas tanks to remain intact at collisions under twenty miles per hour. What about the ethics, though? The question about whether it was right to charge forward was unavoidable because rear-end accidents at speeds greater than twenty miles per hour happen—every day.

The decision was finally made in utilitarian terms. On one side, the company totaled up the dollar cost of redesigning the car’s gas tank. They calculated

• 12.5 million automobiles would eventually be sold,
• eleven dollars would be the final cost per car to implement the redesign.

Added up, that’s $137 million total, with the money coming out of Pinto buyers’ pockets since the added production costs would get tacked onto the price tag. It’s a big number but it’s not that much per person: $11 is about $70 today. In this way, the Pinto situation faced by Ford executives is similar to the test cancellation question for the College Board: one option means only a little bit of suffering for specific individuals, but there are a lot of them.

On the other side of the Pinto question—and, again, this resembles the College Board predicament—if the decision is made to go ahead without the fix, there’s going to be a lot of suffering but only for a very few people. Ford predicted the damage done to those few people in the following ways:

• Death by burning for 180 buyers
• Serious burn injuries for another 180 buyers
• Twenty-one hundred vehicles burned beyond all repair

That’s a lot of damage, but how do you measure it? How do you compare it with the hike in the price tag? More generally, from a utilitarian perspective, is it better for a lot of people to suffer a little or for a few people to suffer a lot?

Ford answered both questions by directly attaching monetary values to each of the injuries and damages suffered:

• At the time, 1970, US Government regulatory agencies officially valued a human life at $200,000. (That would be about $1.2 million today if the government still kept this problematic measure.)
• Insurance companies valued a serious burn at $67,000.
• The average resale value on subcompacts like the Pinto was $700, which set that as the amount lost after a complete burnout.

The math coming out from this is (180 deaths × $200,000) + (180 injuries × $67,000) + (2,100 burned-out cars × $700) = $49 million. The result here is $137 million worth of suffering for Pinto drivers if the car is redesigned and only $49 million if it goes to the streets as is.

Ford sent the Pinto out. Over the next decade, according to Ford estimates, at least 60 people died in fiery accidents and at least 120 got seriously burned (skin-graft-level burns). No attempt was made to calculate the total number of burned vehicles. Shortly thereafter, the Pinto was phased out. No one has final numbers, but if the first decade is any indication, then the total cost came in under the original $49 million estimate. According to a utilitarian argument, and assuming the premises concerning dollar values are accepted, Ford made the right decision back in 1970.

If every Pinto purchaser had been approached the day after buying the car, told the whole Ford story, and been offered to change their car along with eleven dollars for another one without the gas tank problem, how many would’ve handed the money over to avoid the long-shot risk? The number might’ve been very high, but that doesn’t sway a utilitarian conclusion. The theory demands that decision makers stubbornly keep their eye on overall happiness no matter how much pain a decision might cause certain individuals.

Versions of Utilitarian Happiness

Monetized utilitarianism attempts to measure happiness, to the extent possible, in terms of money. As the Ford Pinto case demonstrated, the advantage here is that it allows decisions about the greater good to be made in clear, objective terms. You add up the money on one side and the money on the other and the decision follows automatically. This is a very attractive benefit, especially when you’re dealing with large numbers of individuals or complex situations. Monetized utilitarianism allows you to keep your happiness calculations straight.

Two further varieties of utilitarianism are hedonistic and idealistic . Both seek to maximize human happiness, but their definitions of happiness differ. Hedonistic utilitarians trace back to Jeremy Bentham (England, around 1800). Bentham was a wealthy and odd man who left his fortune to the University College of London along with the stipulation that his mummified body be dressed and present at the institution. It remains there today. He sits in a wooden cabinet in the main building, though his head has been replaced by a wax model after pranking students repeatedly stole the real one. Bentham believed that pleasure and happiness are ultimately synonymous. Ethics, this means, seeks to maximize the pleasures—just about any sensation of pleasure—felt by individuals. But before dropping everything and heading out to the bars, it should be remembered that even the most hedonistic of the utilitarians believe that getting pleasure right now is good but not as good as maximizing the feeling over the long term . (Going out for drinks, in others words, instead of going to the library isn’t recommendable on the evening before midterms.)

A contemporary of Bentham, John Stuart Mill, basically agreed that ethics is about maximizing pleasure, but his more idealistic utilitarianism distinguished low and highbrow sensations. The kinds of raw, good feelings that both we and animals can find, according to Mill, are second-rate pleasures. Pleasures with higher and more real value include learning and learnedness. These aren’t physical joys so much as the delights of the mind and the imagination. For Mill, consequently, libraries and museums are scenes of abundant pleasure, much more than any bar.

This idealistic notion of utilitarianism fits quite well with the College Board’s response to the KDCP episode. First, deciding against canceling student scores seems like a way of keeping people on track to college and headed toward the kind of learning that rewards our cerebral inclinations. Further, awarding free prep classes to those unable to pay seems like another step in that direction, at least if it helps get them into college.

Versions of Utilitarian Regulation

A narrow distinction with far-reaching effects divides soft from hard utilitarianism. Soft utilitarianism is the standard version; when people talk about a utilitarian ethics, that’s generally what they mean. As a theory, soft utilitarianism is pretty laid back: an act is good if the outcome is more happiness in the world than we had before. Hard utilitarianism , on the other hand, demands more: an act is ethically recommendable only if the total benefits for everyone are greater than those produced by any other act .

According to the hard version, it’s not enough to do good; you must do the most good possible. As an example, think about the test-prep company KDCP under the microscope of utilitarian examination.

• When a soft utilitarian looks at KDCP, the company comes out just fine. High schoolers are learning test-taking skills and tricks that they’ll only use once but will help in achieving a better score and leave behind a sense that they’ve done all they can to reach their college goals. That means the general happiness level probably goes up—or at worst holds steady—because places like KDCP are out there.
• When a hard utilitarian looks at KDCP, however, the company doesn’t come off so well. Can we really say that this enterprise’s educational subject—test taking—is the very best use of teaching resources in terms of general welfare and happiness? And what about the money? Is SAT prep really the best way for society to spend its dollars? Wouldn’t a hard utilitarian have to recommend that the tuition money collected by the test-prep company get siphoned off to pay for, say, college tuition for students who otherwise wouldn’t be able to continue their studies at all?

If decisions about businesses are totally governed by the need to create the most happiness possible, then companies like KDCP that don’t contribute much to social well-being will quickly become endangered.

The demands of hard utilitarianism can be layered onto the ethical decision faced by the College Board in their courtroom battle with KDCP. Ultimately, the College Board opted to penalize the test-prep company by forcing it to offer some free classes for underprivileged students. Probably, the result was a bit more happiness in the world. The result wasn’t , however, the most happiness possible. If hard utilitarianism had driven the decision, then the College Board would’ve been forced to go for the jugular against KDCP, strip away all the money they could, and then use it to do the most good possible, which might have meant setting up a scholarship fund or something similar. That’s just a start, though. Next, to be true to hard utilitarianism , the College Board would need to focus on itself with hard questions. The costs of creating and applying tests including the SAT are tremendous, which makes it difficult to avoid this question: wouldn’t society as a whole be better off if the College Board were to be canceled and all their resources dedicated to, for example, creating a new university for students with learning disabilities?

Going beyond KDCP and the College Board, wouldn’t almost any private company fall under the threat of appropriation if hard utilitarians ran the world? While it’s true, for example, that the money spent on steak and wine at expensive Las Vegas restaurants probably increases happiness a bit, couldn’t that same cash do a lot more for the general welfare of people whose income makes Las Vegas an impossibly expensive dream? If it could, then the hard utilitarian will propose zipping up Las Vegas and rededicating the money.

Finally, since utilitarianism is about everyone’s total happiness, don’t hard questions start coming up about world conditions? Is it possible to defend the existence of McDonald’s in the United States while people are starving in other countries?

Conclusion. In theory, there’s not much divergence between soft and hard utilitarianism. But in terms of what actually happens out in the world when the theory gets applied, that’s a big difference. For private companies, it’s also a dangerous one.

Two further versions of utilitarian regulation are act and rule . Act utilitarianism affirms that a specific action is recommended if it increases happiness. This is the default form of utilitarianism, and what people usually mean when they talk about the theory. The separate rule-based version asserts that an action is morally right if it follows a rule that, when applied to everyone, increases general happiness.

The rule utilitarian asks whether we’d all be benefitted if everyone obeyed a rule such as “don’t steal.” If we would—if the general happiness level increases because the rule is there—then the rule utilitarian proposes that we all adhere to it. It’s important to note that rule utilitarians aren’t against stealing because it’s intrinsically wrong, as duty theorists may propose. The rule utilitarian is only against stealing if it makes the world less happy. If tomorrow it turns out that mass stealing serves the general good, then theft becomes the ethically right thing to do.

The sticky point for rule utilitarians involves special cases. If we make the rule that theft is wrong, consider what happens in the case from the chapter’s beginning: You forgot your pencil on SAT test day, and you spot one lying on an abandoned desk. If you don’t take it, no one’s going to be any happier, but you’ll be a lot sadder. So it seems like rule utilitarianism verges on defeating its own purpose, which is maximizing happiness no matter what.

On the other hand, there are also sticky points for act utilitarians. For example, if I go to Walmart tonight and steal a six-pack of beer, I’ll be pretty happy. And assuming I don’t get caught, no one will be any sadder. The loss to the company—a few dollars—will disappear in a balance sheet so huge that it’s hard to count the zeros. Of course if everyone starts stealing beers, that will cause a problem, but in practical terms, if one person does it once and gets away with it, it seems like an act utilitarian would have to approve. The world would be a happier place.

Advantages and Disadvantages of Utilitarian Ethics in Business

Basic utilitarianism is the soft, act version. These are the theory’s central advantages:

• Clarity and simplicity. In general terms, it’s easy to understand the idea that we should all act to increase the general welfare.
• Acceptability. The idea of bringing the greatest good to the greatest number coheres with common and popular ideas about what ethical guidance is supposed to provide.
• Flexibility. The weighing of individual actions in terms of their consequences allows for meaningful and firm ethical rules without requiring that everyone be treated identically no matter how different the particular situation. So the students whose scores were suspended by the College Board could see them reinstated, but that doesn’t mean the College Board will take the same action in the future (if, say, large numbers of people start stealing test booklets).
• Breadth. The focus on outcomes as registered by society overall makes the theory attractive for those interested in public policy. Utilitarianism provides a foundation and guidance for business regulation by government.

The central difficulties and disadvantages of utilitarianism include the following:

• Subjectivity. It can be hard to make the theory work because it’s difficult to know what makes happiness and unhappiness for specific individuals. When the College Board demanded that KDCP give free classes to underprivileged high schoolers, some paying students were probably happy to hear the news, but others probably fretted about paying for what others received free. And among those who received the classes, probably the amount of resulting happiness varied between them.
• Quantification. Happiness can’t be measured with a ruler or weighed on a scale; it’s hard to know exactly how much happiness and unhappiness any particular act produces. This translates into confusion at decision time. (Monetized utilitarianism, like that exhibited in the case of the Ford Pinto, responds to this confusion.)
• Apparent injustices. Utilitarian principles can produce specific decisions that seem wrong. A quick example is the dying grandmother who informs her son that she’s got $200,000 stuffed into her mattress. She asks the son to divide the money with his brother. This brother, however, is a gambling alcoholic who’ll quickly fritter away his share. In that case, the utilitarian would recommend that the other brother—the responsible one with children to put through college—just keep all the money. That would produce the most happiness, but do we really want to deny grandma her last wish?
• The utilitarian monster is a hypothetical individual who really knows how to feel good. Imagine that someone or a certain group of people were found to have a much greater capacity to experience happiness than others. In that case, the strict utilitarian would have no choice but to put everyone else to work producing luxuries and other pleasures for these select individuals. In this hypothetical situation, there could even be an argument for forced labor as long as it could be shown that the servants’ suffering was minor compared to the great joy celebrated by those few who were served. Shifting this into economic and business terms, there’s a potential utilitarian argument here for vast wage disparities in the workplace.
• The utilitarian sacrifice is the selection of one person to suffer terribly so that others may be pleasured. Think of gladiatorial games in which a few contestants suffer miserably, but a tremendous number of spectators enjoy the thrill of the contest. Moving the same point from entertainment into the business of medical research, there’s a utilitarian argument here for drafting individuals—even against their will—to endure horrifying medical experiments if it could be shown that the experiments would, say, cure cancer, and so create tremendous happiness in the future.

Key Takeaways

• Utilitarianism judges specific decisions by examining the decision’s consequences.
• Utilitarianism defines right and wrong in terms of the happiness of a society’s members.
• Utilitarian ethics defines an act as good when its consequences bring the greatest good or happiness to the greatest number of people.
• There are a variety of specific forms of utilitarianism.
• Theoretically, utilitarianism is straightforward, but in practical terms it can be difficult to measure the happiness of individuals.

Exercise \(\PageIndex{1}\)

• What is a utilitarian argument in favor of a college education? How does it differ from other reasons you might want to go to college or graduate school?
• How could a utilitarian justify cheating on an exam?
• What is a “global ethics”?
• What practical problem with utilitarianism is (to some degree) resolved by monetized utilitarianism?
• What are two advantages of a utilitarian ethics when compared with an ethics of duties?
• What are two disadvantages of a utilitarian ethics when compared with an ethics of duties?
• What’s an example from today’s world of a utilitarian monster?
• What’s an example from today’s world of a utilitarian sacrifice?

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Utilitarianism and the pandemic

Julian savulescu.

1 Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford United Kingdom of Great Britain and Northern Ireland

2 Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford United Kingdom of Great Britain and Northern Ireland

3 Visiting Professorial Fellow in Biomedical Ethics, Biomedical Ethics Research Group, Murdoch Children’s Research Institute, Melbourne Australia

4 Distinguished Visiting Professor in Law, Melbourne Law School, University of Melbourne, Melbourne Victoria, Australia

Ingmar Persson

5 Department of Philosophy, Linguistics and Theory of Science, Gothenburg University, Gothenburg Sweden

Dominic Wilkinson

6 John Radcliffe Hospital, Oxford United Kingdom of Great Britain and Northern Ireland

There are no egalitarians in a pandemic. The scale of the challenge for health systems and public policy means that there is an ineluctable need to prioritize the needs of the many. It is impossible to treat all citizens equally, and a failure to carefully consider the consequences of actions could lead to massive preventable loss of life. In a pandemic there is a strong ethical need to consider how to do most good overall. Utilitarianism is an influential moral theory that states that the right action is the action that is expected to produce the greatest good. It offers clear operationalizable principles. In this paper we provide a summary of how utilitarianism could inform two challenging questions that have been important in the early phase of the pandemic: (a) Triage: which patients should receive access to a ventilator if there is overwhelming demand outstripping supply? (b) Lockdown: how should countries decide when to implement stringent social restrictions, balancing preventing deaths from COVID‐19 with causing deaths and reductions in well‐being from other causes? Our aim is not to argue that utilitarianism is the only relevant ethical theory, or in favour of a purely utilitarian approach. However, clearly considering which options will do the most good overall will help societies identify and consider the necessary cost of other values. Societies may choose either to embrace or not to embrace the utilitarian course, but with a clear understanding of the values involved and the price they are willing to pay.

1. INTRODUCTION

The COVID‐19 pandemic has posed a formidable and virtually unprecedented challenge to health professionals, health systems and to national governments. The potential threat to large numbers of patients has led to restrictions on movement, employment, and everyday life that have impacted the lives of billions and come at massive economic cost. Health systems, facing existing or predicted demand overwhelming capacity, have generated guidelines indicating which patients should receive treatment.

One ethical theory has been both cited and criticized in public debate about pandemic response.

The civil rights office of the US Department of Health and Human Services stated that:

persons with disabilities, with limited English skills, or needing religious accommodations should not be put at the end of the line for health services during emergencies. Our civil rights laws protect the equal dignity of every human life from ruthless utilitarianism.

After the New York Times reported that some state pandemic plans instructed hospitals not to offer mechanical ventilation to people above a certain age or with particular health conditions (e.g. ‘severe or profound mental retardation’ as well as ‘moderate to severe dementia’), the Office for Civil Rights (OCR) responded: ‘… persons with disabilities should not be denied medical care on the basis of stereotypes, assessments of quality of life, or judgments about a person’s relative “worth” based on the presence or absence of disabilities or age’.

Utilitarianism is now often used as a pejorative term, meaning something like ‘using a person as a means to an end’, or even worse, akin to some kind of ethical dystopia. Yet utilitarianism was originally conceived as a progressive liberating theory where everyone’s well‐being counted equally. This was a powerful and radical political theory in the 19th century, when large sections of the population were completely disenfranchised and suffered from institutional discrimination. The theory played a role in antislavery, women’s liberation and animal rights movements. Yet utilitarianism remains relevant in the 21st century. As we will discuss, it may be particularly salient and important to consider in the face of global threats to health and well‐being.

In this paper, we will summarize what utilitarianism is and how it would apply to the COVID‐19 pandemic. Our aim is not to argue that utilitarianism is the only relevant ethical theory, or that a purely utilitarian approach must be adopted. However, it is important to note that whenever a utilitarian solution to a dilemma is adopted, there will be more well‐being or happiness in the world. Typically, some people will be better off. Of course, there may be good ethical reasons to deviate from a pure utilitarian approach, for example in order to protect rights or promote equality. However, considering the alternative will help societies to identify and consider the necessary cost of these other ethical values. Utilitarianism is not the end of ethical reflection, but it is a good place to start.

1.1. What is utilitarianism?

Most moral theories imply that there is a (moral) reason to do what is expected to maximize what is good for all, or more precisely, the net surplus of what is good for all over what is bad for them. This might be called a principle of beneficence . Utilitarians hold that maximizing what is good for all is all there is to morality. It makes moral decisions simple by supplying a single measure of rightness: maximization of utility. In many situations this may be enough, along with rules of thumb with the help of which it could be determined what maximizes utility.

According to most moral theories there are, however, other moral reasons. For instance, utilitarianism has often been criticized for ignoring the question of what is a just or fair distribution of what is good for all. The outcome that generates the greatest good overall may be different from the outcome whose distribution of goodness comes closest to being just or fair. Then the principle of beneficence will have to be balanced against the principle of justice. This will most likely have to be done in an intuitive way. It is very controversial what a just or fair distribution consists in, e.g. whether it consists in getting what is deserved or in more equal shares. This is far too controversial to be settled here. It follows that the issue of balancing justice and beneficence against each other must also be left aside.

Another moral principle is a principle of autonomy, which gives weight to an individual’s freedom to choose and to determine, for themselves, how to live their own life. Individual freedoms may conflict with overall good, for example, when individuals choose to flout social distancing laws, or when individuals demand a scarce resource for themselves or their family members. This also brings us to the issue of whether the principle of beneficence should be impartial and accord the same moral weight to the good of all other individuals or whether it should allow greater weight to the good of those who are close to us (and to human over non‐human beings). For the purpose of discussing what policies societies should adopt to deal with pandemics, it is reasonable to assume impartiality.

A further issue is what constitutes goodness and badness for individuals. According to the most familiar theory, hedonism , what is intrinsically good consists in various positive experiences, of pleasure and happiness. What is intrinsically bad consists in negative experiences of pain and unhappiness. Hedonism is, however, frequently criticized for being too narrow in not recognizing that what we are not aware of can be good or bad for us, e.g. that our partners deceive us, or that the state surveys our behaviour, so cleverly that we never notice it. For such reasons a wider conception of what is intrinsically good or bad for us than hedonism will be assumed here, though to determine its precise import would take us too far afield.

Some moral theories imply that there is a stronger or more stringent moral reason to omit doing harm than to benefit . Thus, they imply that there is a stronger reason to avoid making things worse for somebody by killing them, causing them injury or pain, than to benefit them by preventing them from being killed, injured, etc. With respect to pandemics, considerable moral weight has been attached to harms such as death and disease that can be prevented by various constraints. Therefore, for the present discussion it is better to proceed on the assumption that there is no significant moral difference between harming and omitting to benefit.

Utilitarianism typically accepts that instances of goodness and badness can be aggregated in a quantitative fashion . Thus, consider a very mild pain that is caused by a physical stimulus of one unit and that lasts for 10 min. Now compare 100 instances of such a pain either spread out over 100 lives or over one life lasting many decades with a single instance of excruciating pain caused by 75 units of the physical stimulus lasting for 10 min. According to a standard utilitarian calculus the former outcome is worse than the latter, but this seems implausible. Most of us would prefer 100 instances of mild pain dispersed over our lives than 10 min of excruciating pain. It might be thought that this issue is crucial in the present context, since we will have to balance the deaths of a lower number of people against smaller burdens for a much higher number of people. We will, however, see that what is morally relevant from a utilitarian perspective isn’t death in itself but rather the length and quality of life the deceased would have had if they hadn’t died.

It might be said that what matters in the end is what action actually maximizes what is good for all rather than what action is expected to maximize what is good for all. But our best guide to what will actually happen is what is expected to happen on the best available evidence. So, when we decide what to do, we have to go by what is predicted to be best. This is true in most situations (although in some special cases we know that what is expected to be best is not what will actually be best). The expected utility of an action is the sum of the products of the probability and value of each of the possible outcomes of that action.

1.2. Act and rule utilitarianism

There are two broad schools of utilitarianism. According to act utilitarianism, the right act is the act that produces the best consequences. According to rule utilitarianism, the right rule is the rule that produces the best consequences. The law is often an instantiation of rule utilitarianism: laws are chosen because they bring about the best consequences.

These versions of utilitarianism can come apart. Sometimes an act will clearly have better consequences, or no adverse consequences but a rule proscribes that act.

Principles or laws around non‐discrimination are examples of this. Not considering a person’s advanced age or severe disability (e.g. severe dementia) in the allocation of resources, including ventilators, might mean that another person is unable to access those resources who would have gained greater benefit from it, against act utilitarianism. Yet the rule might still overall have better consequences if the non‐discrimination rule has over‐riding benefits.

1.3. Two level utilitarianism

The two different schools of utilitarianism can be combined. The father of modern utilitarianism, Richard Hare, argued that moral thinking occurs at two levels: intuitive and critical, and that we should move between these depending on the circumstances. At the intuitive level, we have many rough rules of thumb that can be rapidly deployed without protracted and demanding reflection: don't kill, don't steal, be honest, etc. These enable us to act efficiently in everyday life. During a pandemic, doctors and other decision‐makers require rules of thumb. For example, when faced with multiple simultaneous patients in the emergency department it is important to have a way of reaching a decision quickly about which patient to attend to first. Triage rules are potentially justified by a form of rule utilitarianism that enables rapid intuitive decisions.

‘Critical level’ utilitarianism requires choosing the action that will maximize the good when we are thinking in the ‘cool, calm hour’, with all the facts at hand. Hare imagined a decision‐maker who had perfect knowledge of the outcomes of all available options (he called them a ‘utilitarian archangel’). In complex situations, where there is time to do so, we must try to rise to the more reflective and deliberative critical level and ask what action we should endorse. What really is the right answer? Hare argues that in such situations we should employ act utilitarianism (this corresponds to system 1 and 2 thinking in psychology).

We will explore some of the implications of critical level utilitarianism for the current COVID‐19 pandemic. We will also describe plausible rules of thumb that would tend to maximize utility and would be useful in emergency and urgent situations. Box 1 illustrates two questions that have been prominent in the early phase of this pandemic.

Alessandro is a 68‐year‐old doctor. He has moderate chronic obstructive airways disease. He contracts COVID‐19 while caring for patients with the same disease. He develops respiratory failure. Jason is a 52‐year‐old businessman who contracted COVID‐19 while travelling for business reasons. He is otherwise well but develops respiratory failure .

The triage question: There is only one ventilator remaining. Who should receive ventilation?

The UK government received modelling that predicted that COVID‐19 would lead to 500,000 deaths in the absence of measures to reduce spread. This could be reduced to 20,000 by implementing major social distancing measures (lockdown). The economic effects arising from restriction of liberty will predictably result in large numbers of job losses, mental illness, and increased medical risk (e.g. unemployment is associated with increased risk of coronary heart disease) .

Cancellation of elective operations and interventions will result in prolongation of suffering and potentially death. Those suffering from non‐COVID illness may not be able to receive treatment in hospital because there are no beds available .

The lockdown question: How should we balance preventing deaths from COVID‐19 with causing deaths and reductions in well‐being from other causes?

1.4. Utilitarian rules of thumb

There are several rules of thumb that can guide rapid decision‐making about these kinds of cases.

One utilitarian rule of thumb is to save the greatest number (other things being equal). This rule could be applied to the lockdown question by assessing how many lives would be lost if lockdown is applied, or not applied. It could also be used for the triage question: in practice, this would mean considering the following variables:

A. Probability

If Jason has a 90% chance of recovery and Alessandro has a 10% chance, other things being equal, you should use your ventilator for Jason. Indeed, if you treat people like Jason rather than people like Alessandro, you will save nine people instead of one for every 10 treated. That is why probability is a relevant consideration.

B. Duration of treatment

In a setting of scarcity, duration of time on a ventilator has implications for the numbers of lives saved. The longer one person will be on a ventilator, the more people who potentially die because they cannot get access to breathing support. If Alessandro needs a ventilator for 4 weeks, and four others (including Jason) need it for 1 week, the choice is between saving one person or four people. So doctors should take duration of use into account.

C. Resources

When resources are limited, resources equate to numbers of lives. The more resources a treatment or a person uses, the fewer are available for others. Imagine that Alessandro and Jason had identical chances of survival, but Alessandro needed a treatment that required three staff to administer the treatment (e.g. extracorporeal membrane oxygenation [ECMO]—essentially cardiac bypass) and Jason needed a treatment that required only one staff member (e.g. mechanical ventilation). We can potentially save three people with ventilation for every patient we save with ECMO. ECMO should be a lower priority than ventilation.

2. Length of life

According to utilitarianism, how long a benefit will be enjoyed matters—it affects the amount of good produced. Thus for life‐saving treatment, treatment that saves people’s lives for longer is to be preferred over treatments that save life for shorter periods.

According to this criterion, priority should be given to the younger Jason rather than the older Alessandro, because Alessandro is expected to live less long if successfully treated. If it were Jason who was expected to die sooner, utilitarianism would support treating Alessandro, even though he is older.

Age is thus a de facto measure of length. Because older people tend to die sooner than younger people, utilitarianism tends to favour saving the lives of the younger. However, age itself does not matter: it is the expected length of the benefit. This is why utilitarianism is not unfairly discriminatory, and not ‘ageist’ in an ethically problematic sense (we will discuss discrimination further below).

Length of life is also relevant for the lockdown question. It is the length of life extended that matters. This has implications for evaluation of current policy. In the UK, the decision to implement national lockdown at the end of March was influenced by modelling produced by Imperial College (Figure ​ (Figure1 1 ).

Estimated UK death toll in different scenarios. Figure retrieved from https://www.bbc.co.uk/news/health‐51979654 but no longer available

The UK Government opted to try to reduce deaths to 20,000. But it was not clear from the modelling figure of 500,000 how many of these people would have died anyway from other causes, or relatively soon after not contracting COVID‐19. Every year more than 600,000 people die in the UK. For utilitarians, the number of lives saved is irrelevant—it is how long these lives would be prolonged by the intervention.

The average age of death of COVID‐19 patients in Italy was 78. This implies that many of those saved by implementing lockdown would have short life expectancies. The average life expectancy at age 80 is 9 years, and overall, COVID‐19 has been estimated to lead to a loss of 11 life years on average. According to utilitarianism, the value of a year of full quality life is the same regardless of how old a patient is. However, if the pandemic largely affects patients with short life expectancy, the benefit of a lockdown (preventing deaths) would be smaller than a different illness that affected younger patients. The cost of lockdown per year of life saved could be astronomical, when one considers all costs including economic and wider social effects.

At the end of March, economists van den Broek‐Altenburg and Atherly, from the University of Vermont estimated the cost‐effectiveness of implanting large scale protective measures to reduce the spread of COVID‐19. They calculated the cost per Quality Adjusted Life Year (QALY) of a $US 1 trillion economic stimulus package against the number of lost life years potentially averted (up to 13 million in the USA). They estimated that such a package would cost between $75,000–650,000 per QALY. (The US government subsequently approved a $US 2 trillion stimulus package.) That suggests that such measures are unlikely to be cost‐effective according to the usual thresholds applied to the costs of medical interventions to save lives. For example, the upper limit for cost‐effectiveness of an intervention in the USA is often taken to be about $100,000 per year of life saved.

There are two points to make about such an analysis. The first is that assessing the utilitarian answer to the lockdown question is highly dependent on the specific factual answers—the harm averted by acting, the harm caused by acting. It is exceedingly difficult to determine which course of action would be best from the point of view of critical level utilitarianism, partly because of enormous uncertainty about the relevant facts. Secondly, even if lockdown were cost‐effective, it would not be as cost‐effective as different interventions that save babies or young people. For example, if an intervention saved the life of a younger person with a different disease for 50 years, you would only have to save one‐fifth as many to bring about as much benefit. It costs a few dollars to save the life of a child in a developing country.

While interventions to prevent COVID‐19 may be cost‐effective (though this seems perhaps unlikely), they are unlikely to be the most cost‐effective actions that we could take. There are likely to be better investments for utilitarians. As an example, The Gates Foundation has estimated that global eradication of malaria by the year 2040 would cost up to $120 billion. Such an initiative (costing only 1/15th as much as the US pandemic stimulus package) would potentially save 11 million lives.

3. Quality of life

Utilitarians consider not just how long someone will live after treatment but how well they will live. They consider quality of life important.

This could be relevant to the triage question (as suggested in the quote from the Office for Civil Rights at the start of this paper).

Consider an extreme example. The end point of dementia is unconsciousness. Imagine that of our two patients with respiratory failure Alessandro is still working, in possession of all of his faculties. Jason, by contrast (in this version of the case) has end stage dementia. According to utilitarians, we should treat Alessandro if we cannot treat both. Jason would derive zero benefit from being kept alive in an unconscious state. Indeed, this would apply potentially even if Jason (with dementia) had a higher chance of survival, or were going to survive for longer.

What about lesser degrees of cognitive impairment or other disabilities? According to utilitarians, these would also be considered in making allocation decisions if they affect the person’s well‐being.

However, comparisons of overall well‐being between individuals are not straightforward. It is not necessarily the case that someone with a disability would have lower well‐being than someone without a disability. Probably the most profound question in ethics is what makes a person’s life good, or constitutes well‐being. Philosophers have debated this question for thousands of years. Answers include happiness, desire fulfilment or flourishing as human animals (which includes having deep relationships with others and being autonomous, amongst other things).

As a heuristic for triage, it may be that in developed countries a threshold is set at a level where overall well‐being is certain to be low. One practical cut off would be unconsciousness or severe disorders of consciousness, such as being in a minimally conscious state. It is highly unlikely to be cost‐effective to provide intensive care for a patient who is permanently minimally conscious. Lines could be drawn where there is more uncertainty, and may need to be in countries with more limited resources, or if the demand were much greater. For example, the threshold might be set at the ability to recognize and respond meaningfully with other people. So, on this approach, cognitive impairments that reduced the capacity to have minimal human relationships would reduce priority for treatment as a proxy for believed reduced well‐being.

Quality of life may also be relevant to the lockdown question. If the life years saved by lockdown were likely to be of reduced quality that would influence how much benefit overall is gained, and therefore what economic cost would be worth incurring.

4. Equivalence of acts and omissions, withdrawing and withholding

For utilitarians, how an outcome arises is morally irrelevant. It makes no difference if it is the result of an act, or an omission.

Doctors, patients and families, however, hold that there is a moral difference between acts and omissions. Many people hold a causal account of responsibility: they tend to think that we are responsible for the consequences of our acts but not for our omissions. Thus people tend to believe that withdrawal of life‐sustaining treatment is morally worse than withholding life‐sustaining treatment.

This folk commitment to a causal sense of responsibility and the acts/omission distinction has a number of bad consequences.

It means that there is considerable attention in pandemic guidelines to decisions about initiation of treatment. The ‘triage question’ is largely or entirely focused on whether to start treatment. Withholding of treatment from patients with poorer prognosis is often thought to be ethically acceptable. However, some apparently poor prognosis patients will do well and a trial of treatment might provide more accurate prognostic information. Thus, under conditions of uncertainty, a trial of treatment with the possibility of withdrawal would be preferable to withholding treatment.

Utilitarianism would reject the idea of employing any form of ‘first come, first served’ to decide about treatment. The timing of when a patient arrives needing treatment is morally irrelevant to whether or not they should receive treatment. This is a principle that we have elsewhere labelled the principle of temporal neutrality . According to utilitarianism, doctors should be prepared to withdraw treatment from poor prognosis patients in order to enable the treatment of better prognosis patients if they arrive later.

Consideration of acts and omissions is also relevant to wider social questions raised by the pandemic. Failing to implement a good policy is equivalent to actively implementing a bad policy, when the outcome of the two decisions is the same. So utilitarians hold policy makers responsible not only for what they do, but for what they fail to do. Failing to implement other policies, with the result of avoidable, foreseeable deaths is equivalent to killing for utilitarians. (This means that policy makers are just as blameworthy for failing to eradicate malaria as they would have been if they had failed to act in response to coronavirus.)

5. Social benefit

According to utilitarianism, all the consequences of actions, both short and long term, direct and indirect are relevant to decisions. Thus it may be relevant to consider not only the benefit to the person directly affected by an action (for example, by being placed on a ventilator), but also others. This can be called ‘social benefit’ or social worth.

In pandemics, one rule of thumb likely to maximize utility would be to give priority to health care workers, those providing key services and others who are necessary to provide essential benefits to others. This has been applied in many countries, including the UK, to testing for coronavirus. However, it might also apply to access to ventilators or other medical treatments. A reason given for this is that it will potentially mean that they can also return to work sooner.

What about the social worth of others? Should criminals have a lower priority in accessing limited resources? What about scientists working on a vaccine? Related to social benefits is the issue of dependents. Should pregnant women and parents of dependent children be given greater priority for health care? Developing rules of thumb for assessing social worth is ethically and epistemically complex, liable to abuse and difficult to enforce fairly. Critical level utilitarianism would likely not endorse such priority rules, perhaps beyond prioritizing critical essential services workers (which is relatively clear cut and easy to enforce and has wide social acceptance).

Utilitarianism is sensitive to the potential for abuse of its operationalized principles. If there is a risk that a principle will be abused, this should be taken into account in deciding whether to operationalize it or not. For example, social worth is easily abused by the powerful to claim privilege and priority.

6. Responsibility

For utilitarians, we are morally responsible to the extent that the effects of our acts or omissions are foreseeable and we have control over them. Intentions are irrelevant for utilitarians. It is not what we want to happen that matters: it is what we can foresee, and what actually happens. So even if consequences are unintended, we are still responsible if they are foreseeable and avoidable.

This implies that failing to take a course of action that would bring about more good, or avert more harm, is equivalent to intentionally causing that harm. The moral responsibility for choosing an inferior policy is high for utilitarians and actions that result from this are subsequently blameworthy.

Utilitarianism is a very demanding theory in several ways. Whenever we foreseeably and avoidably bring about a less good state of affairs, we are morally responsible and blameworthy. If bringing about the best policy requires more research, we are responsible for the deaths that occur because that research was not done.

Another issue in resource allocation is responsibility for illness. Many people have the intuition that responsibility for illness should be taken into account in the allocation of limited resources. Smokers should receive lower priority for lung transplants, drinkers for liver transplants. The UK government has also encouraged the public to take responsibility for their health. In the case of COVID‐19, people with various comorbidities have worse prognoses. For example, type II diabetes is one such comorbidity, and its risk factors include so‐called 'lifestyle' factors such as diet and exercise.

There are numerous problems with trying to use responsibility for illness in the allocation of resources. Utilitarians eschew all direct consideration of causal contribution to illness and, indeed, any ‘backward looking’ considerations like desert. They are only concerned with bringing about the best outcome. If, for example, diabetes reduces the chance of survival, it is relevant insofar as it reduces the chance of survival, not because it was the result of any voluntary behaviour.

Responsibility (or the disposition to behaviour that led to ill health) is only relevant for utilitarians insofar as it affects probability, length or quality of survival. This is in line with how responsibility is generally used in the NHS.

7. Avoid psychological biases, intuitions and heuristics

Utilitarianism seeks to avoid biases, emotions, intuitions or heuristics that prevent the most good being realized.

For example, humans are insensitive or numb to large numbers. They are also more moved by a single identifiable individual suffering than by large numbers of anonymous individuals suffering each to the same extent (this is the so‐called ‘rule of rescue’). Thus they will be motivated to alleviate the suffering of a single highly publicized individual, rather than taking action that prevents suffering of a larger amount of unknown or unidentifiable individuals. To some extent, national responses to COVID‐19 might represent a massive form of the ‘rule of rescue’.

Probably most relevant to political decision‐making is bias towards the near future. The desire to avoid deaths now is stronger than the desire to avoid deaths in the future. It is psychologically easier to impose severe lockdown now in the name of saving lives threatened now, even if the toll of loss of life would be greater in the future. There is some evidence that the lockdown and related factors such as reduced access to medical care are leading to additional deaths from causes other than coronavirus. It might be anticipated that there will be large numbers of future deaths caused by the economic downturn induced by the pandemic. After the 2008 financial crash it is estimated that there were 250,000 excess cancer deaths just in Organisation for Economic Co‐operation and Development countries.

These future and non‐identifiable deaths might be greater than or less than those prevented by lockdown. They are hard to predict and even to confidently assign, which is one reason that they are difficult to take into account. However, they are just as ethically relevant as the deaths caused by COVID‐19. We should not ignore them because they are less psychologically real and motivating.

Utilitarianism aims to the maximize the good, impartially conceived. Statistical lives matter as much as identifiable lives.

Another bias is to one’s family and friends. According to utilitarianism, we should give equal weight to the lives of strangers, even those in other countries. The effects on the pandemic in Africa are yet to be documented or manifest. Given that there are fewer advanced life support systems, the mortality is likely to be greater. Utilitarianism would favour diverting resources there if the effects would be greater.

Much of ordinary decision‐making is driven by emotion, biases and heuristics. Thus, much of utilitarianism will strike ordinary people as counterintuitive.

1.5. The triage question

The above rules of thumb could be assembled into an algorithm for allocation of ventilators (Figure ​ (Figure2). 2 ). Such an algorithm could be used to inform rapid decisions if there were overwhelming numbers of patients presenting in future surges relating to COVID‐19. Alternatively, it might be used to inform decisions about highly scarce and expensive treatments such as ECMO. Because of the need for rapid decisions, based on limited information, this represents an attempt to guide ‘intuitive level’ decisions in a way that would generate most benefit overall. It is thus different from what act utilitarianism (or the critical level approach) would recommend.

An ethical algorithm for rationing life sustaining treatment

The algorithm divides decision‐making into stages, and prioritizes on the basis of different criteria, depending on the availability of resources. For example, it starts by giving highest priority to those with the highest chance of surviving and needing the lowest duration of treatment. This would maximize the number of lives saved. If there are sufficient ventilators to treat all patients with at least a moderate chance of surviving, there would be no need to invoke other criteria. Thus, for example, health care systems with ample pre‐existing intensive care capacity, or who have been able to expand their capacity acutely, might have no need to ration on the basis of life expectancy or quality of life.

If there are insufficient ventilators, additional principles might be invoked. As noted, utilitarianism does not necessarily seek to save most lives, but would aim to achieve the most well‐being overall, including elements of both length of life and quality of life. At a second level, triage might assess both of these factors for patients in need of treatment. In practice, however, estimation of predicted quality adjusted life years for individual patients is highly complex (and may be uncertain). It would be quicker to set a threshold of length and quality of life worth saving. As an example, we have suggested that a health system under severe pressure might elect to only provide mechanical ventilation to patients predicted to survive for at least 5 years with normal quality of life, but the specific threshold used will depend on the level of resource availability and on the level of demand.

1.6. The lockdown question

While the triage question lends itself to heuristics, and the development of a rule that might generate the best outcome overall, it is difficult to know what intuitive‐level response would be best for the lockdown question. Because of the scale of the impact of the pandemic, there is a danger that rapid rule‐based responses might go badly wrong and lead to a much worse outcome overall. Instead, this is a question that would be better answered by drawing on critical level utilitarianism. In large part because of uncertainty, there are different views about which strategy for entering or leaving lockdown would generate the best outcome overall. For example, there remains debate about whether the approach in Sweden (avoiding a national lockdown) is better or worse than the approach of Sweden’s Scandinavian neighbour Norway, which implemented a lockdown in early March. At the time of writing, Sweden has reported 2,769 deaths, (274 deaths/million population), compared with 214 deaths in Norway (39/million population).

The important issue for utilitarians is not the number of deaths, but the QALYs lost. Because a large proportion of the deaths in Sweden are in care homes, there may be fewer QALYs lost than a policy that caused a smaller number of avoidable deaths of younger, healthier people. What is important is whether the QALYs lost in Sweden are greater or less than Norway, overall, as a result of the policy. It is far from clear at this point the answer to that question.

Moreover, there can be difficulties in comparing countries, since they differ in more than just the policy applied. They may also differ in other characteristics. The mortality of Stockholm stands out in Sweden: half of Sweden's deaths were in Stockholm, yet its population is roughly 1/5 th of Sweden’s: specifically, 1,428 out of 2,854 deaths (May 5, 2020). The mortality rate of a region in the south of Sweden with a population of 1.4 million was half that of Oslo, the capital region of Norway (April 21, 2020), in spite of not having had a lockdown policy for 5 or 6 weeks. The number of deaths in this southern region is 78 compared to 1,428 in Stockholm whose population is only a couple of hundred thousand greater (May 5, 2020). One potential explanation for differences in mortality relates to differences in population density. Another relates to the amount of circulating coronavirus prior to any change in community behaviour (which may or may not have been imposed formally as a lockdown). A further factor may be whether the virus has had access to vulnerable groups. The virus may have been more effectively kept out of aged care in the south of Sweden. That it isn’t simply due to a national lockdown is confirmed by the fact that this mortality figure is lower both than that of the neighbouring Danish capital, Copenhagen, 293, and the county surrounding it, 93 (May 5, 2020), despite that fact that shops, etc. have been locked down in Copenhagen since mid‐March.

It might be that conditions all over Sweden will soon be worse than in Norway and Denmark because of the absence of a national lockdown. However, it is possible that Norway and Denmark’s approach might lead to more deaths at a later stage because of further surges of the virus when lockdown is relaxed. More importantly, as we have argued, the number of deaths from COVID‐19 at a given point in time is not decisive. The question is which strategy will prevent the most deaths from any cause (and more importantly preserve the most years of life in full heath). We must keep in mind the prospect of wider harms to the community as a result of lockdown and the economic consequences.

It is difficult to know what overall strategy would be best. There are several clear points, though about how utilitarianism would inform a policy response to the lockdown question.

1.7. Evidence sensitivity

Utilitarianism is highly dependent on accurate information about the world. It requires good evidence. Without good evidence, it is less likely that we would choose means that will bring about the most good.

Utilitarianism is thus complementary to science—it requires science. Thus utilitarianism will urge more research to get better estimates of consequences and probabilities from a wide range of possible courses of action. Utilitarianism invites scientific inquiry. The Swedish approach to lockdown has been informed by epidemiological models of the impact of coronavirus that were lower and less dramatic than some of the models used elsewhere (for example in the UK). Any modelling or data that is used to inform decision‐making should be openly available and subject to peer review. If the evidence changes, or the modelling needs to be revised, policy should also change. This means that countries might need to change their policy. That could mean relaxing lockdown, or implementing stricter lockdown. The UK government changed tack in its response to coronavirus in late March in response to revised modelling. That does necessarily mean that the previous policy was mistaken. As noted, utilitarianism directs decisions on the basis of expected utility. Where our expectations change, decisions should change too.

For example, in order to get better estimates of true mortality, utilitarianism would support random population testing to see the incidence of COVID‐19 in asymptomatic or minimally symptomatic community members.

Sometimes the opportunity costs of gathering more information or evidence will be prohibitive when urgent action is needed. In these cases, it is important that beliefs are as rational as possible. They should result from wide expert dialogue, embracing the possibility of dissensus.

1.8. Global, impartial equality

Critical level utilitarianism requires impartial and equal consideration of the well‐being of all sentient creatures. In this case, it requires consideration of people now and in the future, as well as people without coronavirus who might be affected by lockdown. It includes the well‐being of all people, old and young, sick and well, in one’s own country and internationally.

This means that it is critical to assess both the well‐being costs of COVID‐19, and the well‐being costs of lockdown. There is currently huge attention to quantifying the numbers of cases of COVID‐19 infection and the number of consequent deaths. However, there is much less attention to the possible consequences of lockdown measures for people without coronavirus. Recent figures (at the end of April) suggest that the UK has had a large increase in all‐cause mortality—the highest in Europe, and that this rate has not been decreasing even as reported deaths from COVID‐19 have fallen. There is an urgent need to identify and quantify deaths (and more importantly loss of years of well‐being) from all causes in order to inform decisions. Deaths or illness from COVID‐19 might be greater in number than other causes (or they might not), but they are not ethically more important than those from other causes.

Lockdown measures themselves will have direct morbidity and mortality (through denial or delay of medical treatment), as well as indirect effects through economic recession. One estimate is that 25 million jobs will be lost worldwide with associated loss of well‐being and death.

According to utilitarianism, the right policy is the one that maximizes well‐being overall, across all people across all countries. Utilitarianism embraces radical impartial equality—all well‐being and deaths are equal (other things being equal). The cause of loss of well‐being does not matter. Thus, a utilitarian policy will only invest in preventing loss of life from COVID‐19 provided it is the most efficient way of saving all lives.

We have noted already that other global health priorities might be considerably more cost‐effective than the financial costs of responding to coronavirus. However, there are other important global considerations. The UK has banned the sale of 80 drugs to other countries in a bid to prevent NHS shortages. From a utilitarian perspective, this may be the wrong course of action if the sale of the drugs would save more lives globally if exported. There may be a moral obligation to help others that overrides the obligation to one’s own citizens. Many countries have sourced large numbers of ventilators in order to be able to meet anticipated demand in their own country. However, the consequences of the pandemic may be much more severe in low and middle income countries (LMIC). Some of the investment that countries have made into their own (already well‐resourced) health care systems would yield much greater benefit for LMIC. That might include making ventilators available (poor countries have been outbid by wealthy countries in the scramble to purchase ventilators). It might include support for LMIC policies that are less costly but potentially effective ways of averting the crisis (for example, Vietnam employed mass testing and contact tracing to prevent the spread of COVID‐19, and as a result, reported zero COVID‐19 deaths at the end of April). Policy makers in LMIC may benefit from some of the modelling and scientific expertise available in other countries to support their decision‐making. It has been questioned whether isolation will work in Africa or whether it will kill more young people through its economic effects and subsequent malnutrition.

For utilitarians, policy will need to be sensitive to context and facts about individuals and local communities. The policy that is best for one country may be worst for another.

Utilitarianism is a theory with no national boundaries.

1.9. Well‐being matters more than rights and liberty

For utilitarianism, well‐being is all that matters. Liberty and rights are only important insofar as they secure well‐being. Thus a utilitarian approach to the lockdown question may be prepared to override the right to privacy or liberty to protect well‐being.

Vietnam, Singapore, Taiwan and China have used methods such as tracing contacts and enforcing self‐isolation using mobile phone data, with severe penalties for failure to comply (in Singapore, it is up to 6 months gaol). These countries have been highly effective at containing COVID‐19, more so than liberal Western countries with greater emphasis on rights and liberties. Utilitarians support the East Asian approach of constraining liberty and privacy to promote security and well‐being. This approach also appears cost‐effective while delayed response may not be.

One recent suggestion has been an app that facilitates contract tracing. However, participation in the programme is meant to be voluntary: people would need to agree to share information about their whereabouts and health status. Utilitarianism would favour a more coercive approach if this is more effective. Those who favour such voluntary programmes give greater weight to consent and privacy than to well‐being and life. This is a value choice: it chooses individual rights over overall reduction in the spread of disease. Of course, countries are free to pursue individual freedom, but if the liberty based approach is less effective, it will necessarily come at the cost of additional cases of COVID‐19 and additional deaths.

Importantly, the extent of the liberty restriction or rights violation should be commensurate with the effect on well‐being. Utilitarianism would support isolating certain groups if the benefit to them was greater or the benefit to others was greater. Thus a utilitarian approach to lockdown might favour selective isolation of the elderly and other vulnerable groups if that was the most cost‐effective way to secure overall well‐being.

Likewise, the restriction of liberty of low risk groups may also be necessary to secure large collective benefits. This justifies, for example, in the case of influenza, vaccinating children, who are at low risk of flu complications, in order to protect the elderly, who have less effective immune responses to vaccination and are at greater risk of flu complications. Although children have little expectation of benefit themselves from vaccination, vaccinating children is necessary to secure benefits to overall well‐being that cannot otherwise be achieved. (It would also support challenge studies being performed [voluntarily] on low risk populations for a COVID‐19 vaccine, e.g. young people.)

It is often objected that utilitarianism leads to discrimination against those in ‘protected’ categories, such as the elderly, disabled, women, ethnic minority groups, etc. For example, in COVID‐19, it appears that elderly, male, obese, and BAME patients have a worse prognosis than other groups (to varying degrees). Utilitarians, it is argued, will give lower priority to some or all of these groups for access to limited resources and/ or a higher priority to isolating these groups, which is discrimination.

The first issue at hand is the accuracy of the information. For example, apparent differences in mortality between groups may be mere proxy correlations, that arise from unrelated factors such as faster spread amongst different groups in the community meaning there is uneven distribution of cases in the first place (we still do not know the true number of cases due to testing shortages in nearly all countries), the presence or absence of different groups in high‐risk occupations (in addition to uneven distribution of cases, there may be a ‘dose‐dependent’ effect of the viral load on the severity of illness making some workers more vulnerable), existing comorbidities that are correlated with different groups, but unrelated to them and should be considered separately, or poorer care due to bias or lack of access. Moreover, identification and analysis of these factors may lead to the ability to apply effective focussed measures such as equipping care homes with better testing and protective equipment, or focussed testing measures. Utilitarianism fails if it is applied unscientifically, without fine‐grained information, or if it fails to consider the best policy responses.

If the evidence associating a group of people with higher mortality is indeed both accurate and predictive of a higher mortality, and the association is of sufficient strength, and the proposed policy is both necessary and effective, then assigning resources or burdens such as lockdown selectively is no more discriminatory than other policies, such as the selective isolation of people on the basis of a proxy risk factor for infection, such as travel history or contact with someone who has COVID‐19 (this was the early strategy).

Nevertheless, there would still be utilitarian reasons to reject policies that give lower priorities to these groups. In particular, these groups (with the exception of males) have already been disadvantaged, and indeed this disadvantage may even be the direct cause of vulnerability to COVID‐19. Justice requires that they not be further disadvantaged. Accepting the validity of justice need not mean rejecting utilitarianism. Utilitarians must consider all the effects of their policies and actions. If some policy will perpetuate or exacerbate discrimination or injustice with concomitant effects on well‐being, these must be considered. Loss of short‐term utility is justified by the larger long‐term gains of a more just society.

In any case, as we outlined at the beginning of this paper, utilitarianism is not necessarily a complete answer: one can sacrifice utility for other values. Thus, there might be straightforwardly utilitarian reasons for treating different groups in the same way: the resulting fractures in society arising from a policy that did not do so would ultimately cause a greater loss of well‐being. Or there might be pure justice reasons: upholding central values such as justice is more important than the net difference in expected health outcomes.

A key aspect of the law on discrimination is proportionality. In a pandemic, very large numbers of lives are at stake. Equality, even for those opposed to utilitarianism, is only one value amongst others. Discrimination may be proportionate if the stakes are high enough and alternative measures are not available.

1.10. Separateness of persons

One prominent objection to utilitarianism is that it fails to respect the separateness of persons. One instantiation of this problem that is relevant to pandemic management is that utilitarianism can favour very small risk reductions spread over very large numbers of persons rather than the saving of one long life. Small goods can be summed to outweigh one large good.

Insofar as this is a problem, it can be avoided in practice by only comparing and summing comparable goods, for example lives. For example, one could count only the saving of lives or the saving of a life for a sufficiently long period of time (say 1 year) as a minimum good to be counted.

This vice can also be a virtue. The significant misery that a large number of people experience during lockdown (unemployment, depression, being victims of domestic violence, etc.) should not be ignored and must be recognized as an ethical cost. If that well‐being loss is great enough for a large enough number of people it could outweigh even the loss of some years of life for a relative few.

1.11. Conclusion

Utilitarianism is a demanding and counterintuitive theory. Why should we consider it? If the utilitarian course of action is not adopted, someone (often many) people will suffer or die avoidably. There may be good reasons (such as the preservation of liberty) to sacrifice well‐being or lives. But such choices need to be made transparently and in full awareness of their ethical cost. One must have good reasons to deliberately choose a course of action that will be worst overall.

Policy is often driven by politics or popular opinion, not ethics. This is morally wrong. Much of ethics in the public sphere involves social signalling, moralism and sometimes wishful thinking (for example, trying to wish away difficult ethical dilemmas). Careful consideration of the consequences of our actions requires us to face the facts and our values. A utilitarian approach is not simple, or easy. It requires that we choose the course of action that will benefit most people to the greatest degree, however difficult or counterintuitive that is.

There is some support for utilitarianism. In one survey investigating the public’s views on how to allocate intensive care beds amongst critically ill infants, we found the general public widely supported utilitarian allocations. They supported allocating the intensive care bed to save the infant with a greater chance of survival, who would have a longer life or less disability. They also supported saving the greater number. This suggests that there may be public support for the algorithm that we have proposed for the triage question. When people understand that there is an unavoidable need to choose between patients, they appear to recognize that securing the most benefit overall is both logical and ethical.

One of the psychological biases that dominates decision‐making is loss aversion. Losses loom larger than gains. And when we evaluate a policy we are liable to focus on the negatives, rather than the positives. Thus governments, such as East Asian governments, who radically curtail liberty and protect health and security are criticized for being overly authoritarian. Liberal governments that protect liberty and incur greater infection risks (such as the UK and Australia) are criticized for failing to protect the vulnerable and secure public health. There is no win the in the court of public opinion.

That is why we need, in the cool, calm hour, to set our policy objectives and priorities. Utilitarianism gives a clear framework for that. And it gives criteria to judge success.

The universal common ethical currency is well‐being. What matters to each of us is how well our lives go. This is the very heart and basis of utilitarianism: it takes an impartial approach to everyone’s well‐being. While people may argue other things matter (autonomy, privacy, dignity), everyone can agree that well‐being matters.

It is doubtful that any of the policies currently being adopted by any governments worldwide are purely or simply utilitarian. However, some are potentially reflecting more clearly and carefully about the costs and benefits of different courses of action and policy. The fundamental difficulty facing all of us during this pandemic is that we cannot know for certain which action will be best overall. We do not know what a utilitarian ‘archangel’ would choose: it would require a detailed understanding of the science and facts, the nature of well‐being and an exhaustive understanding of the consequences of our choices. But that is what we should be aspiring to. We must strive to get the facts straight on all the consequences of our choices. Our societies may then choose to embrace or choose not to embrace the utilitarian course. But at least we will then do so with a clear understanding of our values and the price we are willing to pay for them.

Acknowledgements

JS and DW were supported by the Wellcome Trust (WT203132). JS through his involvement with the Murdoch Children's Research Institute was supported by the Victorian Government's Operational Infrastructure Support Program.

Biographies

Julian Savulescu has held the Uehiro Chair in Practical Ethics at the University of Oxford since 2002. He has degrees in medicine, neuroscience and bioethics. Since 2017, he has been Visiting Professorial Fellow in Bioemedical Ethics and group leader for the Biomedical Ethics Research Group at the Murdoch Children’s Research Institute, and Distinguished International Visiting Professor in Law at Melbourne University. At the University of Oxford, he directs the Oxford Uehiro Centre for Practical Ethics within the Faculty of Philosophy, co‐directs the Wellcome Centre for Ethics and Humanities, and leads a Wellcome Trust Senior Investigator award on Responsibility and Health Care.

Ingmar Persson is Emeritus Professor of Practical Philosophy, University of Gothenburg, and Distinguished Research Fellow, Oxford Uehiro Centre of Practical Ethis. His books on ethics include Inclusive Ethics (OUP, 2017) and, with Julian Savulescu Unfit for the Future (OUP, 2012).

Dominic Wilkinson is Professor of Medical Ethics at the Oxford Uehiro Centre for Practical Ethics, University of Oxford. He is also a consultant in newborn intensive care at the John Radcliffe Hospital, Oxford. His co‐authored books include ‘ Medical Ethics and Law , third edition’ (Elsevier 2019); ‘ Ethics, Conflict and Medical treatment for children, from disagreement to dissensus ’ (Elsevier, 2018). He is the author of ' Death or Disability? The ' Carmentis Machine ' and decision‐making for critically ill children ’ (OUP 2013).

Savulescu J, Persson I, Wilkinson D. Utilitarianism and the pandemic . Bioethics . 2020; 34 :620–632. 10.1111/bioe.12771 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]

Utilitarianism

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